Provider Demographics
NPI:1821286683
Name:BALLADARES, JORGE L (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:L
Last Name:BALLADARES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8420 W FLAGLER ST
Mailing Address - Street 2:SUITE 222-A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2046
Mailing Address - Country:US
Mailing Address - Phone:305-226-1181
Mailing Address - Fax:305-226-4836
Practice Address - Street 1:8420 W FLAGLER ST
Practice Address - Street 2:SUITE 222-A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2046
Practice Address - Country:US
Practice Address - Phone:305-226-1181
Practice Address - Fax:305-226-4836
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0012101122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist